New mother 'suffered haemorrhaging'
A new mother who died days after her son was born had suffered "haemorrhaging of a significant but unknown amount" around the time of childbirth, the doctor who delivered her baby has told an inquest.
Gemma Mizon was a registrar in obstetrics and gynaecology at the Princess Royal University Hospital in Bromley, south east London, when Gillian Nelson gave birth to her son Wesley on January 28 2014 at 4.03am. She had been admitted for an induced delivery.
Miss Mizon told the inquest into Ms Nelson's death, at Southwark Coroner's Court, that she had shown "no sign of ongoing bleeding" at the time and denied removing blood clots from the patient.
The inquest had heard that Ms Nelson had reported to a member of staff that she had lost some blood while in a toilet, before giving birth.
Complications arose and the 34-year-old businesswoman, of Sydenham, south east London, suffered bleeding and was also seen to have low blood pressure and high pulse.
She went into shock and needed urgent surgery. She also had multiple cardiac arrests and was taken to theatre for a hysterectomy.
Ms Nelson's widower James Ramirez, 37, fears "there was some gaps in her monitoring" and recalls her looking "delirious, spaced out, obviously tired" and pale after giving birth.
She was later moved to King's College Hospital (KCH) in Denmark Hill, south east London, where her family was told she needed a liver transplant.
The family was later told they were "out of options" and Ms Nelson died on February 2.
Coroner Dr Andrew Harris asked Miss Mizon if, in hindsight, she felt it may have been possible to have called in a consultant at an earlier stage, in an effort to seek out any active bleeding, given that Ms Nelson had been in shock.
Miss Mizon said Ms Nelson had "lost a certain amount of blood" but "was not displaying any signs of any ongoing bleeding actively".
The blood needed for Ms Nelson came "quickly" and, according to Miss Mizon, "she was transfused and she was not displaying any sign of abdominal pain or abdominal tenderness or that she was actively bleeding".
While speaking to Miss Mizon, the coroner described it as "such a rare event" adding: "Despite her clinical status it seemed more than likely that it (her status) could be compensated and there was no indication that there was something to explore (in terms of ) internal bleeding."
Miss Mizon, who looked as though she was on the point of tears, replied: "That's correct," before the coroner called for a temporary break in the proceedings.
Miss Mizon recalled that Ms Nelson had appeared "very distressed" when she went into labour.
She claimed she had only learned later from Ms Nelson that she had suffered blood loss while in a toilet before the birth.
Miss Mizon had described this information as "important" because "later on in the management of this lady when her haemoglobin had dropped significantly (it seems) she had had a blood loss that had not been witnessed by any of the staff".
A bedside test on Ms Nelson's haemoglobin was carried out soon after the baby was born.
Miss Mizon stressed "there was no evidence of any bleeding", adding: "We did a point test which did show a significant drop in her haemoglobin which was a surprise to me."
Miss Mizon estimated she had witnessed about 800mls of blood loss and that fluids were given to the patient.
Ms Nelson was asked further questions about her situation but Miss Mizon noted that an acute bleed was not reflected in the immediate haemoglobin.
The coroner noted that "this lady is in shock" and suggested that she "must have lost more than 800mls, would it be rather that she must have lost two litres?"
Miss Mizon agreed and recalled that Ms Nelson was at that stage looking pale, but still coherent and managing to talk.
The court has heard that Ms Nelson's condition went downhill between 4.25am and 5.45am. Ms Nelson "visibly became breathless" and was taken to theatre for surgery by 6.40am.
Asked by the coroner if there were any lessons to be learned, Miss Mizon responded: "Certainly this case has highlighted the importance of always thinking of bleeding that you can not see."
Consultant obstetrician Dr Dede Ofili-Yebovi said a uterine tear was found.
Dr Ofili-Yebovi, who was called at around 6.37am, got stuck in traffic and arrived at the hospital at 7.55am.
She said the expectation is that consultants should be able to get to an emergency within 30 minutes.
Dr Ofili-Yebovi said she thought she would make it within that time after setting out immediately after getting the call.
The hearing was adjourned until tomorrow at 9am.